Managed Care Nursing

Category - Healthcare Management

Which of the following is incorrect regarding NCQA utilization management structure recommendations?
  1. A physician or midlevel provider participates in decision making
  2. A written plan is created for care management
  3. A plan is created with physician leadership for behavioral health aspects
  4. Annual review, update or revisions are completed
  5. None of the above
Explanation
Answer: A - NCQA utilization management structure recommendation includes a physician as part of the decision making process, a written plan for how care is managed, a plan with physician leadership for behavioral health and annual review, update or revisions.
NCQA utilization management structure does not include a physician or midlevel provider in the decision-making process.
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